人工环成形术与改良De Vega成形术治疗功能性中、重度三尖瓣关闭不全伴右心功能不全的临床疗效比较

Comparison of clinical efficacy of artificial annuloplasty versus modified De Vega valvuloplasty for treatment of functional moderate and severe tricuspid incompetence with concomitant right cardiac insufficiency

目的比较人工环成形术与改良De Vega成形术治疗功能性中、重度三尖瓣关闭不全伴右心功能不全患者的临床疗效。方法回顾性分析106例行左心瓣膜置换手术同期行三尖瓣成形术的患者的临床资料,根据手术方法分为人工环成形组56例(A组)与改良De Vega成形组50例(B组)。比较两组患者术前及术后10 d、6个月、2年的心脏B超指标[心室心肌做功指数(Tei指数)、左心室射血分数(LVEF)、右心房横径(RAD)、右心室内径(RVD)、三尖瓣反流程度(TRD)、三尖瓣环直径(TVAD)、肺动脉收缩压(PASP)],观察两组患者围术期不良事件的发生情况。结果两组患者围术期均无死亡病例,均无三尖瓣不良事件需再次手术的病例;术中开放上下腔静脉、停机后经食管超声观察均未见三尖瓣明显反流。术后10 d和6个月,两组所有的心脏B超指标差异均无统计学意义(均P>0.05);术后2年,A组的Tei指数、RAD、RVD、TRD、TVAD、PASP均低于B组,LVEF值高于B组(均P<0.05);两组的LVEF值均随时间延长而逐渐升高,其余指标均随时间延长而逐渐降低,分组与时间均有交互效应(均P<0.05)。结论对于功能性中、重度三尖瓣关闭不全伴在右心功能不全患者,人工环成形术与改良De Vega成形术均能明显降低三尖瓣关闭不全的反流量和改善右心功能,两者近期效果相似,但术后2年人工环成形术在改善右心功能方面优于改良De Vega成形术。

Objective To compare the clinical efficacy of artificial annuloplasty versus modified De Vega valvuloplasty for the treatment of patients with functional moderate and severe tricuspid incompetence with concomitant right cardiac insufficiency.Methods The clinical data of 106 patients undergoing left heart valve replacement and concurrent tricuspid valvuloplasty were analyzed retrospectively.According to the surgical approaches,the patients were divided into artificial annuloplasty group(group A,n=56)and modified De Vega valvuloplasty group(group B,n=50).The two groups were compared in terms of cardiac B-ultrasonic indices(ventricular myocardial performance index[Tei index],left ventricular ejection fraction[LVEF],right atrial diameter[RAD],right ventricular diameter[RVD],tricuspid regurgitation degree[TRD],tricuspid valve annulus diameter[TVAD],pulmonary artery systolic pressure[PASP])before operation and 10 days,six months and two years after operation,and the incidence of perioperative adverse events was observed in both groups.Results No perioperative death or averse tricuspid events-caused reoperation cases occurred in the two groups,and no evident tricuspid regurgitation was observed on transesophageal echocardiography after opening the superior and inferior vena cava during operation or after ventilator withdrawal.There were no statistically significant differences in cardiac B-ultrasonic indices between the two groups 10 days and six months after operation(all P>0.05).Two years after operation,group A exhibited lower Tei index,RAD,RVD,TRD,TVAD and PASP and higher LVEF than group B(all P<0.05);in both groups,LVEF increased gradually and the remaining indices decreased gradually over time,there was an interactive effect between group and time(all P<0.05).Conclusion For patients with functional moderate and severe tricuspid incompetence with concomitant right cardiac insufficiency,both artificial annuloplasty and modified De Vega valvuloplasty can significantly reduce the regurgitation of tricuspid incompetence and improve right cardiac function,and their short-term effects are similar,but two years after operation,artificial annuloplasty is superior to modified De Vega valvuloplasty in improving right cardiac function.